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b G C <br /> Burnett County Office of Zoning Administrator CD <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> a Permit for the work described and located as shown herein. The undersigned agrees that <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, a''1 . p <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and re gu- :'ca :'`' <br /> lations of the State of Wisconsin. <br /> Owner or Agent (please print) Contractor or Surveyor : =" <br /> Address Address <br /> �4 <br /> �ic'!-Sd!''`� Cl <br /> Plumber r Vk4l- ier f'��'N e' r_iJ,s rr4�v i a 1 <br /> ..... . .... ....!S .. .. ..'°� 1"... .'Y. ... .. .. .. .. .. ..... . . .. .. .. .. . `, e-r e <br /> Address Address <br /> Phone ...... .. ........ ........... .. .... .. ..... . . .. . . .. .. . . ... . . .. .. .. <br /> Phone ° <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities : <br /> 1. Work (check one) Type of Construction No. Bathrooms <br /> Dishwasher ..10.. r* X� <br /> New Building -•• •••... ......... • •• • Garbage Grinder : : Z "� <br /> Addition Size . .. ft. x .. . . . ft. Autom. Laundry '-'J. .ft. -� <br /> Sanitary 1t•. No. Bedrooms <br /> Alterations ...... Height . .. . Stories ... . Waste Disposal �7 <br /> Moving ...... <br /> Area System . .. .. . <br /> Wrecking ... Septic Tank Size <br /> Mobile Home ..... . 5. Permits Required <br /> Gallons <br /> Privy Subdivision <br /> Well • •�,• • Sanitary .X Absorption Fief Site _ <br /> Soil Type . .:�.:'.;J S c <br /> Subdivision Building • • Slope . . . . . .. .. . . . c <br /> Well x . Perc. Rate <br /> 2. Classification Other (Specify) .. Dry Well . .. .. . <br /> Zoning Dist. . ..... Conditional • ••.•• Seepage Trench <br /> Land Privy <br /> 3. Lot Size 6. Use (describe exactly, 1- Seepage Bed /�•.`/ `' c CQ <br /> fam. home, motel, etc.) FOR COMMERCIAL USE ;a <br /> . .. .... ft. x .. .... . ft. Plans Submitted . .. .. . <br /> . . . .. .. . . .. .. . ... sq. ft. Plans Approved . .. ... <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- •jZ <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test must be attached to this application before a <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM :�t <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />